RESUMEN
Ð clinical case of a young patient with recurrent ischemic strokes is presented. The problems of diagnostic embolic strokes are discussed. We set out the algorithm for identifying patients, in whom patent foramen ovale is the most probable cause of embolic stroke. Detailed consideration of imaging diagnostic methods possibility is included. Hypothesis of probable source of cardioembolism from patent foramen ovale is presented. Recommendations for the secondary prevention of recurrent ischemic stroke, associated with patent foramen ovale, are provided. We also considered the issues of antithrombotic treatment.
Asunto(s)
Accidente Cerebrovascular Embólico , Foramen Oval Permeable , Accidente Cerebrovascular , Humanos , Foramen Oval Permeable/diagnóstico , Foramen Oval Permeable/diagnóstico por imagen , Fibrinolíticos/uso terapéutico , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Prevención Secundaria/métodosRESUMEN
Aim To evaluate 30-day results of the transcatheter correction of degenerative aortic stenosis using a novel self-expandable valve, PorticoTM.Material and methods Transcatheter aortic valve implantation (TAVI) was performed in 42 patients with an intermediate surgical risk (mean age, 74.3±6.5 years, 8 men, 34 women, EuroSCORE II risk, 2.5 (1.5;4.1)) with severe degenerative aortic stenosis (AS). 20 (48â%) patients had ischemic heart disease; 8 (19%) of patients had atrial fibrillation, and 16 (38%) of patients had type 2 diabetes mellitus. Most of the patients (88â%) had preserved systolic function, and 5 patients had a pronounced decrease in left ventricular ejection fraction. Early efficacy and safety of the intervention were evaluated with VARC-2 criteria.Results In-hospital and 30-day mortality following TAVI was absent. Also, there were no adverse events, including cerebrovascular disorders, perioperative myocardial infarction, and conversion to open surgery. One patient had prosthesis migration to the aorta, which required implantation of the second self-expandable valve. Mean duration of the procedure was 90 min (80;110), fluoroscopy time was 21 min (19;24), and contrast volume 154âml (200;240). Following TAVI, the mean aortic valve (AV) pressure gradient significantly decreased from 56.1±21.2 to 11.2±4.0âmm Hg, the maximal gradient decreased from 88.9±27.8 to 20.0±7.0 mm Hg, and the AV effective orifice area increased from 0.67±0.2 to 1.9±0.3 cm2 (p<0.001). By the time of discharge from the hospital, all patients showed regression of AS clinical manifestations. The percentage of patients with NYHA functional class III chronic heart failure reduced from 62â% to 7â% (p<0.001) after TAVI. In one case after the implantation, grade 3 aortic regurgitation was observed, which required endovascular occlusion to close the paraprosthetic fistula. Moderate paraprosthetic regurgitation (grade <2) was observed in 3 (7â%) patients. Only 2 (4.8%) patients required permanent pacemaker implantation.Conclusion Results of the single-center prospective TAVI study using a novel self-expandable valve PorticoÑм showed satisfactory hemodynamic parameters, efficacy and safety of the procedure for the 30-day follow-up period. A relatively low radial force of the carcass can be beneficial for reducing the incidence of permanent pacemaker implantation after TAVI.
Asunto(s)
Estenosis de la Válvula Aórtica , Diabetes Mellitus Tipo 2 , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Reemplazo de la Válvula Aórtica Transcatéter , Anciano , Anciano de 80 o más Años , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/diagnóstico , Estenosis de la Válvula Aórtica/cirugía , Femenino , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Masculino , Estudios Prospectivos , Volumen Sistólico , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Resultado del Tratamiento , Función Ventricular IzquierdaRESUMEN
A 58-year-old female patient with severe chronic heart failure and mitral regurgitation receiving an optimal drug therapy was implanted with an Optimizer Smart device for modulation of cardiac contractility and underwent transcatheter mitral plasty using a MitraClip system. The complex therapy resulted in a significant clinical improvement and beneficial dynamics of echocardiographic parameters.
Asunto(s)
Insuficiencia Cardíaca , Implantación de Prótesis de Válvulas Cardíacas , Insuficiencia de la Válvula Mitral , Cateterismo Cardíaco , Femenino , Insuficiencia Cardíaca/cirugía , Humanos , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/cirugía , Resultado del TratamientoRESUMEN
This article presents a clinical case of successful transcatheter aortic valve implantation in an elderly patient with critical aortic stenosis at the stage of systolic dysfunction with development of genuine cardiogenic shock. The role of transcatheter aortic valve implantation in the pathogenetic treatment of acute heart failure due to decompensated aortic stenosis was briefly discussed.
Asunto(s)
Estenosis de la Válvula Aórtica , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Reemplazo de la Válvula Aórtica Transcatéter , Anciano , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/diagnóstico , Estenosis de la Válvula Aórtica/cirugía , Humanos , Choque Cardiogénico/etiología , Choque Cardiogénico/cirugía , Resultado del TratamientoRESUMEN
AIM: To evaluate the effect of angiotensin-neprilysin receptor inhibitors on myocardial remodeling in patients with chronic heart failure and atrial fibrillation. MATERIALS AND METHODS: We studied dynamics of the parameters of ultrasound structural and functional parameters of the left atrium and left ventricle of the heart was during 3-month therapy with sacubitryl-valsartan in a group of 15 patients with a combination of chronic heart failure due to dilated and paroxysmal paroxysmal forms of atrial fibrillation. RESULTS: Showed a statistically significant positive effect of the use of angiotensin receptors and neprilysin inhibitors on the parameters of remodeling of the left atrium (according to transthoracic and transesophageal echocardiography), left ventricle, as well as levels of natriuretic peptides ANP and NT-pro-BNP. CONCLUSION: The use of ARNI may be promising in terms of treatment and prevention of AF in patients with heart failure.
Asunto(s)
Fibrilación Atrial , Insuficiencia Cardíaca , Aminobutiratos , Humanos , Péptido Natriurético Encefálico , Neprilisina , Receptores de Angiotensina , TetrazolesRESUMEN
AIM: To evaluate the diagnostic utility of long-term remote monitoring of ECG compared with 24 hour Holter monitoring for the detection of cardiac arrhythmias and conduction disturbance in patients with atrial fibrillation (AF) after catheter radiofrequency ablation (RFA; isolation) of the pulmonary veins. MATERIALS AND METHODS: The study included 62 patients aged 58.5±11.1 years, with paroxysmal or persistent AF, after catheter RFA (pulmonary veins isolation). Patients underwent long-term remote ECG monitoring, 24 hour Holter monitoring and transthoracic echocardiogram. RESULTS: After 24 hour Holter monitoring of 62 patients with AF after RFA in 21 of them (33.9%) was detected early recurrence of AF. Remote ECG monitoring of 18 patients, detected AF in 7 patients (39%), 2 of them were asymptomatic AF recurrence. 24 hour Holter monitoring of the same 18 patients AF recurrence was not detected at all (0%). CONCLUSION: Both of devices, long-term remote monitoring of ECG and 24 hour Holter monitoring detected 45.2% of recurrence of AF. Over the wearing of both devises 24 hour Holter and long-term remote monitor the last detected more events among 18 patients (33% vs 0%). Two evens of AF recurrence were asymptomatic.